Building a breast cancer detection and treatment platform in the Democratic Republic of the Congo by integrating training, service and infrastructure development

Kabongo Mukuta Mathieu; Tankoy Gombo YouYou; Michael L Hicks; Alex Mutombo; Mukanya Mpalata Anaclet; Mulumba Kapuku Sylvain; Leeya Pinder; Maya M Hicks; Louis Kanda; Mirielle Kanda; Groesbeck P Parham; Ronda Henry-Tillman

doi:10.3332/ecancer.2021.1233

Building a breast cancer detection and treatment platform in the Democratic Republic of the Congo by integrating training, service and infrastructure development

Ecancermedicalscience. 2021 May 13:15:1233. doi: 10.3332/ecancer.2021.1233. eCollection 2021.

Authors

Kabongo Mukuta Mathieu¹, Tankoy Gombo YouYou¹, Michael L Hicks^{2

3

4

5

6

7}, Alex Mutombo¹, Mukanya Mpalata Anaclet¹, Mulumba Kapuku Sylvain¹, Leeya Pinder^{8

9}, Maya M Hicks^{10

11}, Louis Kanda¹², Mirielle Kanda¹², Groesbeck P Parham^{2

3

13}, Ronda Henry-Tillman¹⁴

Affiliations

¹ Biamba Marie Mutombo Hospital, No. 9777, Boulevard Lumumba, Commune de Masina, Kinshasa, Democratic Republic of the Congo.
² Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, 101 Manning Dr, Chapel Hill, NC 27514, USA.
³ Department of Obstetrics and Gynecology, University Teaching Hospital - Women and Newborn Hospital, 10101 Nationalist Way, Lusaka, Zambia.
⁴ St Mary Mercy Cancer Center, 36475 Five Mile Rd, Livonia, MI 48154, USA.
⁵ St Joseph Mercy Oakland Cancer Center, 44405 Woodward Ave, Suite 202, Pontiac, MI 48341, USA.
⁶ McLaren Macomb Medical Center, 1000 Harrington Blvd, Mount Clemens, MI 48043, USA.
⁷ https://orcid.org/0000-0002-1819-155X.
⁸ Department of Oncology, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA.
⁹ https://orcid.org/0000-0002-8929-7810.
¹⁰ Howard University College of Medicine, 520 W St NW, Washington, DC 20059, USA.
¹¹ https://orcid.org/0000-0002-1993-3367.
¹² Dikembe Mutombo Foundation, 400 Interstate N Pkwy, Suite 1040, Atlanta, GA 30339, USA.
¹³ https://orcid.org/0000-0002-1782-9523.
¹⁴ Winthrop P Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, 4301 West Markham St, Slot #725, Little Rock, AR 72205, USA.

Abstract

Background: Breast cancer is a leading cause of cancer-related morbidity and mortality in sub-Saharan Africa, a global region where opportunities for breast care of any type are extremely limited due to insufficient infrastructure, a paucity of clinical services and vast shortages of trained human resources.

Methods: A team of Zambian and US gynaecologic and breast oncology experts and nurse-specialists made multiple visits (each lasting 5 working days) to the Democratic Republic of the Congo (DRC), over a 2-year period. During each of five week-long site visits, hands-on training of local Congolese health providers was conducted during which time they were taught clinical breast exam (CBE), breast and axillary ultrasound, ultrasound-guided core needle biopsy/fine needle aspiration (FNA) and breast surgery. Simultaneous with the training exercises, a new breast care clinic was established and operationalised, and existing surgical theatres were upgraded. All activities were implemented in a private sector health care facility - Biamba Marie Mutombo Hospital - in the capital city of Kinshasa.

Results: From April 2017 to August 2020, a total of 5,211 women were identified as having breast abnormalities on CBE. Ages ranged from 26 to 86 years; median age: 42.0 (±14.1) years. Ultrasound abnormalities were noted in 1,420 (27%) clients, of which 516 (36%) met the criteria (indeterminate cystic lesion, solid or suspicious masses) for ultrasound-guided core needle biopsy or FNA. Pathology reports were available for 368 (71%) of the 516 clients who underwent biopsy, of which 164 were malignant and 204 benign. The majority (88%) of the cancers were advanced (TNM stages 3 and 4). Surgical procedures consisted of 183 lumpectomies, 58 modified radical mastectomies and 45 axillary lymph node dissections. Clinical competency for diagnostic and surgical procedures was reached early in the course of the training programme.

Conclusion: By integrating onsite training with simultaneous investments in clinical service and infrastructure development, the barriers to breast cancer diagnosis and treatment were disrupted and a modern breast care service platform was established in a private sector health care facility in the DRC.

Keywords: Democratic Republic of Congo; breast cancer; cancer control in Africa; capacity building; surgical training in LMIC; woman’s breast cancer center in Africa.